Patient, Public & Media Information

Other Reimbursement Issues

Proper and fair reimbursement for work done and care given is a key issue monitored by AAOS. There are a number of areas where this applies.

- Medicaid reimbursement rates - it is essential that states provide a fair level of payment for treating Medicaid patients. It is not only good for the physician, it is necessary to ensure that Medicaid patients will continue to be able to find physicians who are willing to treat them.

- "Downcoding" and bundling - when insurers don't pay doctors and hospitals for all the services they've performed in one examination this discourages doctors from providing necessary treatment and burdens hospitals with losses from treating insured patients.

- No-fault auto insurance versus the tort system for paying for treatments arising from auto accidents: No-fault systems are generally seen as preferable by physicians as they are more likely to result in timely reimbursement, unlike states that rely on the tort system, where physicians can wait years to get reimbursed, if ever. Tort systems are not just hard on physicians. Many consumers have had their credit ruined by slow- or non-payment of medical bills. Health insurance premiums often go up to respond to the diminished coverage available under auto policies, and the costs incurred by those without health insurance may end up being shifted to the taxpayer.

- reimbursement for treating drunk drivers. Many states allow insurers to not reimburse for accidents caused by an intoxicated driver. While these statutes are designed to punish the drunk driver, health care professionals also suffer. They are obligated to treat the injuries of the drunk driver, but may never be reimbursed for this work.